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Showing content from https://pubmed.ncbi.nlm.nih.gov/26535565/ below:

Outreach invitations for FIT and colonoscopy improve colorectal cancer screening rates: A randomized controlled trial in a safety-net health system

Randomized Controlled Trial

. 2016 Feb 1;122(3):456-63. doi: 10.1002/cncr.29770. Epub 2015 Nov 4. Outreach invitations for FIT and colonoscopy improve colorectal cancer screening rates: A randomized controlled trial in a safety-net health system Amit G Singal^{1 2 3 4}, Jasmin A Tiro^{3 4}, Celette Sugg Skinner^{3 4}, Katharine McCallister³, Joanne M Sanders³, Wendy Pechero Bishop^{3 4}, Deepak Agrawal¹, Christian A Mayorga¹, Chul Ahn^{3 4}, Adam C Loewen³, Noel O Santini², Ethan A Halm^{1 2 3 4}

Affiliations

¹ Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
² Parkland Health and Hospital System, Dallas, Texas.
³ Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
⁴ Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.
⁵ Veterans Affairs San Diego Health Care System, San Diego, California.
⁶ Division of Gastroenterology, Department of Internal Medicine, Moores Cancer Center, University of California at San Diego, La Jolla, California.

PMID: 26535565
PMCID: PMC4724227
DOI: 10.1002/cncr.29770

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Randomized Controlled Trial

Outreach invitations for FIT and colonoscopy improve colorectal cancer screening rates: A randomized controlled trial in a safety-net health system

Amit G Singal et al. Cancer. 2016.

. 2016 Feb 1;122(3):456-63. doi: 10.1002/cncr.29770. Epub 2015 Nov 4. Authors Amit G Singal^{1 2 3 4}, Samir Gupta^{5 6}, Jasmin A Tiro^{3 4}, Celette Sugg Skinner^{3 4}, Katharine McCallister³, Joanne M Sanders³, Wendy Pechero Bishop^{3 4}, Deepak Agrawal¹, Christian A Mayorga¹, Chul Ahn^{3 4}, Adam C Loewen³, Noel O Santini², Ethan A Halm^{1 2 3 4} Affiliations

¹ Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
² Parkland Health and Hospital System, Dallas, Texas.
³ Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
⁴ Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.
⁵ Veterans Affairs San Diego Health Care System, San Diego, California.
⁶ Division of Gastroenterology, Department of Internal Medicine, Moores Cancer Center, University of California at San Diego, La Jolla, California.

PMID: 26535565
PMCID: PMC4724227
DOI: 10.1002/cncr.29770

Item in Clipboard

Abstract

Background: The effectiveness of colorectal cancer (CRC) screening is limited by underuse, particularly among underserved populations. Among a racially diverse and socioeconomically disadvantaged cohort of patients, the authors compared the effectiveness of fecal immunochemical test (FIT) outreach and colonoscopy outreach to increase screening participation rates, compared with usual visit-based care.

Methods: Patients aged 50 to 64 years who were not up-to-date with CRC screening but used primary care services in a large safety-net health system were randomly assigned to mailed FIT outreach (2400 patients), mailed colonoscopy outreach (2400 patients), or usual care with opportunistic visit-based screening (1199 patients). Patients who did not respond to outreach invitations within 2 weeks received follow-up telephone reminders. The primary outcome was CRC screening completion within 12 months after randomization.

Results: Baseline patient characteristics across the 3 groups were similar. Using intention-to-screen analysis, screening participation rates were higher for FIT outreach (58.8%) and colonoscopy outreach (42.4%) than usual care (29.6%) (P <.001 for both). Screening participation with FIT outreach was higher than that for colonoscopy outreach (P <.001). Among responders, FIT outreach had a higher percentage of patients who responded before reminders (59.0% vs 29.7%; P <.001). Nearly one-half of patients in the colonoscopy outreach group crossed over to complete FIT via usual care, whereas <5% of patients in the FIT outreach group underwent usual-care colonoscopy.

Conclusions: Mailed outreach invitations appear to significantly increase CRC screening rates among underserved populations. In the current study, FIT-based outreach was found to be more effective than colonoscopy-based outreach to increase 1-time screening participation. Studies with longer follow-up are needed to compare the effectiveness of outreach strategies for promoting completion of the entire screening process.

Keywords: colonoscopy; colorectal cancer screening; fecal immunochemical test; navigation; randomized controlled trial; safety-net health system.

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Conflict of interest statement

Conflicts of Interest: None of the authors have any conflicts of interest to declare.

Figures
Figure 1

The study flow is depicted.

Figure 1

The study flow is depicted.

Figure 1

The study flow is depicted.

Figure 2

On ITT analyses, screening completion…

Figure 2

On ITT analyses, screening completion was higher for FIT outreach vs. usual care…

Figure 2

On ITT analyses, screening completion was higher for FIT outreach vs. usual care (p<0.0001), colonoscopy outreach vs. usual care (p<0.0001), and FIT vs. colonoscopy outreach p< 0.001). Among FIT and colonoscopy outreach group subjects completing screening, crossover to visit-based usual care screening was higher in the colonoscopy outreach group (52.2% of all screening completers) than in the FIT outreach group (20.9% of all screening completers), as represented by the white and dark shading for usual care FIT and visit-based colonoscopy within each bar, respectively (p< 0.0001).

Figure 3

Among responders, FIT outreach had…

Figure 3

Among responders, FIT outreach had a higher proportion of “early responders” prior to…

Figure 3

Among responders, FIT outreach had a higher proportion of “early responders” prior to telephone reminders (59.0% vs. 29.7%, p< 0.0001), and shorter mean time to outreach response (24.3 ± 26.4 vs. 29.8 ± 24.6 days, p< 0.0001) compared to colonoscopy outreach.